Most Common Cause of Fetal Death During Pregnancy
Abruptio placentae is the most common cause of fetal death during pregnancy among the options provided. 1, 2
Understanding Placental Abruption
Placental abruption is defined as the premature separation of the placenta from the uterine wall before delivery. This condition:
- Complicates approximately 0.4-1% of all pregnancies 2
- Is one of the leading causes of vaginal bleeding in the latter half of pregnancy 1
- Represents a significant cause of perinatal mortality and morbidity 1
- When involving more than 50% of the placenta, is frequently associated with fetal death 1
Risk Factors for Placental Abruption
Several factors increase the risk of placental abruption:
- Prior history of abruption 1
- Smoking and cocaine use 1
- Trauma 1
- Multifetal gestation 1
- Hypertension and preeclampsia 1, 3
- Thrombophilias 1
- Advanced maternal age 1
- Preterm premature rupture of membranes 1
- Intrauterine infections 1
- Hydramnios 1
- Poor maternal nutrition during pregnancy 4, 5
Comparison with Other Causes of Fetal Death
Maternal Demise
While maternal death can certainly lead to fetal death, it is not the most common cause. Maternal mortality in developed countries has decreased significantly, though cardiovascular disease remains the leading cause of pregnancy-related deaths in the United States 3.
Subarachnoid Hemorrhage
Subarachnoid hemorrhage is a rare but serious complication during pregnancy. While it can lead to maternal mortality, it is not among the most common causes of fetal death 3.
Penetrating Fetal Injury
Penetrating fetal injuries are rare and typically associated with trauma. While trauma can lead to placental abruption and subsequent fetal death, direct penetrating injuries to the fetus are much less common than abruption as a cause of fetal death 6.
Clinical Significance of Placental Abruption
- In developed countries, approximately 10-20% of all perinatal deaths are caused by placental abruption 2
- The rate of placental abruption has been increasing in many countries 2
- Elevated white blood cell count (>20,000/mm³) on admission in pregnant trauma patients should raise suspicion of placental abruption 6
- Placental abruption is associated with maternal poverty and undernutrition during pregnancy in some populations 4, 5
Maternal Consequences of Placental Abruption
- Obstetric hemorrhage 2
- Need for blood transfusions 2
- Emergency hysterectomy 2
- Disseminated intravascular coagulation 2
- Renal failure 2
While maternal death is rare in cases of placental abruption, the maternal mortality rate is approximately seven times higher than the overall maternal mortality rate 2.